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The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).

The Latham technique is the initial interventional procedure used to treat the facial orthopedic problems found in unilateral cleft lip and palate (UCLP) and bilateral complete cleft lip and palate (BCLP) patients. In UCLP and RCLP deformities, the soft tissue and basal abnormalities have a recognizable pattern of deformity defined by excess or deficiency in anatomic form, position, or direction within the craniofacial milieu. The Latham appliance applies controlled directional forces to reposition the displaced basal segments and realign soft tissue margins of like kind before corrective surgery is performed.This study presents a literature review, explains the clinical technique used for BCLP and UCLP patients, evaluates the initial orthopedic effect caused by the Latham technique, examines the fistulation rate after two closure operations (i.e., lip and alveolar, and later palate), and presents case demonstrations with one UCLP and two BCLP patients. LITERATURE REVIEWThe Latham technique is a variation on an approach that was introduced several decades ago. In the early 1950s, M~N e i l ' .~ and Burston3 first reported on the use and advantages of presurgical orthopedic correction (POC) in UCLP and BCLP patients. Still in use today, the POC technique employs a passive oral prosthesis and external facial or head straps to effect segment repositioning. Another variation of POC for use in UCLP patients, reported Supported in part by rcsearch grant 88-65, Sinai Hospital, lktroit, Mich. Downloaded by: Universite Laval. Copyrighted material.

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Image corrected cephalometric analysis (ICCA) is a method for eliminating serial image parallax error. In a radiographic survey, image parallax is an inherent and random property of the two-dimensional image of the subject. Radiographs of the same subject taken at different times will be different in image parallax. This difference, parallax error, is routinely displayed between serial radiographic studies. Parallax error discourages the use of conventional serial cephalometric surveys for tracking and studying changes in discrete craniofacial structures lying outside the midsagittal plane, unilaterally disposed, or changing without bilateral symmetry. Anatomic outlines or discrete points of such structures would routinely display measurement perturbations caused by image parallax differences between surveys. The ICCA method eliminates this problem. Therefore, accurate serial measurements of bone marker point displacements are made possible with two-dimensional reconstructions of points lying in three-dimensional space. The method of ICCA was tested for accuracy by using zero time serial cephalometric surveys of five subjects. Mean implant error of 0.12 mm (SD = 0.1) was found between predicted (ICCA) and actual measured implant movement caused by the image parallax error. After applying this method, bone marker movements are unlikely to be caused by parallax error between conventional serial cephalometric studies. Furthermore, displacement growth can be related to the relocation of composite growth outlines and midline anatomic landmarks. One plagiocephaly case and one hemifacial microsomia case were used to demonstrate ICCA for growth and treatment effect documentation.